Negotiated health benefits changes coming soon
By DEBORAH STAYMAN
If you have questions contact Lorraine Simpkins or Deborah Stayman at 1-800-342-4306 or 518-785-1900 ext. 283
Starting July 1, Empire Plan will cover shingles vaccine
If you are age 55 or older, ask your doctor if you should be vaccinated against shingles (herpes zoster), a condition often marked by debilitating pain.

In May, the national Centers for Disease Control and Prevention (CDC) recommended a single dose of the vaccine, Zostavax, for persons age 60 and older, even if they have already had an episode of shingles.

Starting July 1, this vaccination will be covered by the Empire Plan for enrollees age 55 and older.

If you’ve ever had chickenpox, you may someday have shingles. According to the CDC, more than 95 percent of people are infected by the varicella zoster virus which causes chickenpox in children and then becomes dormant in the nerves.

If it reactivates later in life, it can cause shingles, which is characterized by clusters of blisters that develop on one side of the body in a band-like pattern and can cause severe pain that lasts for weeks, months or years. About one-third of people will develop shingles and the risk increases to 50 percent if you live to age 85. Long-term complications can include loss of vision or hearing or even become life-threatening.

Zostavax has been shown to reduce the incidence of shingles in persons over the age of 60 by about 50 percent.
Children who have never had chickenpox should get two doses of the chickenpox vaccine starting at age 12 months.
                                                                                                                            — Deborah Stayman

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Article 9 Benefit Current Level New Level
9.2(a) Prospective Procedure Review (PPR) Prior notification of elective Magnetic Resonance Imaging (MRIs) required PPR expanded to include MRIs, CT scans, Positron Emission Tomography (PET) scans, nuclear medicine and Magnetic Resonance Angiography (MRAs)
9.2(d)Travel Expenses for Cancer Resource Services (CRS) & Transplant Centers of Excellence (COE) 1) Meals & lodging: CRS-$50/day; $100/day for two COE -$100-$200/day; $150-$250/day for two
2) CRS lifetime max: $10,000
1) Reimburse meals & lodging using Federal reimbursement rates
2) Eliminate $10,000 CRS lifetime max
9.2(e) Ambulatory surgicenter copay $15 $30
9.2(f) Reasonable & Customary (R&C) charge for injectable medications billed by doctor Based on actual charges (PEF-only benefit) Actual charge or average wholesale price, whichever is less
9.3(p) Home Care Advocacy Program (HCAP)-Diabetic Shoes Not covered Provide benefits for one pair diabetic shoes per year through HCAP. Network-Paid in full up to $500
Non-network-Subject to Basic Medical deductible, then plan pays 75% of network allowance up to $500
9.3(v) Adult Immunizations Limited to specific illnesses Add Herpes Zoster (shingles)
9.3(y) Diabetes Education Centers Diabetes education covered Expand network to include Diabetes Education Centers (Effective 7/1/08 or as soon as practicable.)
9.10(c) Dependent Student Coverage 3-month extension upon graduation Continue coverage for 3 months following completion of semester
9.20(a) Employee Removed from Payroll Due to Work-Related Assault 10%/25% employee share of premium for up to 12 months, employee pays 100% of premium after 12 months Continue employee share (10%/25%) for up to 24 months
9.22 Empire Plan Prescription Drug Program
Tier 3 Copays (all other copays remain the same)
30 days retail or mail: $30
31-90 days mail: $55
31-90 days retail: $60
30 days retail or mail: $40
31-90 days mail: $65
31-90 days retail: $70
“New to You” Dispensing Limit No limitation 1) Must fill one 30-day script before getting 90-day fill
2) Initial script can be for 90 days but will be split. Patient pays 30-day copay for 30-day fill & then difference between 90-day copay and 30-day copay for 31-90 day fill.
Effective 7/1/08 or as soon as practicable
9.25 Vision Benefits Enrollees cannot have an eye exam one day and wait to select eyewear on a different day (i.e., “split the benefit”) Enrollees will have 90 days from date of exam to purchase eyewear. Effective 7/1/08 or as soon as practicable